Management of postoperative pain in patients taking buprenorphine for opioid use disorder

* Severe pain often occurs after major spine surgery, thoracotomy, major open abdominal surgery, or mastectomy.

¶ Expect to need higher doses of opioids for patients taking buprenorphine than opioid naïve patients. Commonly used full mu opioid agonists are fentanyl, morphine, hydromorphone, and oxycodone. For patients with pain that is not well controlled with other opioids, transition to hydromorphone or fentanyl, which have high affinity for the mu opioid receptor.